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					 Local Number Portability (LNP)                                                                                                           PowerTel Limited
 Porting Authorisation Form                                                                                                                             ABN 69001760103


Porting Local Numbers
Pursuant to the agreement between insert Customer name, ABN insert ABN (“Customer”) and insert Current Carrier (“Current Carrier”), the Customer is the
legal lessee of the service numbers listed in the table below, which have existing account numbers also listed in the table below or authorised agent for the lessee
of those service numbers.
  Is the Current Carrier also the local access provider for the services that the numbers        Yes       go to Service section
  are to be ported from?                                                                         No        complete next item
 Is the Current Carrier rebilling line rental charges for the services that the numbers are                  Yes         local access provider is: select the provider
 to be ported from?                                                                                                      local access provider account number:
                                                                                                             No          this may be a 3 party port, seek SCC assistance

Service
 Port numbers to an        Yes      , service number:                   Attach access service Application, only complete:           Service Location Details
 existing PowerTel                                                                                                                  Equipment Maintainer Contact Details
 access service?           No                                           Attach access service Application, complete:                all sections
 What is your preferred time for the port to take place          Preferred Day of Week: Please Select        Preferred Time of Day: Please Select
 PowerTel will schedule the earliest possible time as possible to the preferred time. A PowerTel representative will confirm that the booked port time with the
 customer is appropriate. Please allow 2 hours to complete a port.
 If a new access service, how will PowerTel provide an outgoing service at this site prior to the numbers being ported to PowerTel?
  The new PowerTel access service will be used for outgoing calls before porting                     or       go to Numbers To Be Ported section
  An interim PowerTel Long Distance service is required temporarily until porting                             complete Interim Long Distance section

 Interim Long Distance Service
 Apply PowerTel Long Distance override code using LCR to the service numbers listed                                No       go to Numbers To Be Ported section
 on this form until the PowerTel access service is connected to the customer equipment?                            Yes      obtain authorisation here
                                                                                                        Sales Manager authorising signature:
 Include local calls in interim LCR programming:    Yes        No                                       
 Package / Plan: Same rates to apply on interim Long Distance service as will apply on PowerTel access service when connected

Numbers To Be Ported
Number(s) to be ported to PowerTel Limited:
    Number(s) to be Ported                  Current Carrier              In Rotary              Number(s) to be Ported               Current Carrier          In Rotary
        (ten digits)                       Account Number              Group or EBD                 (ten digits)                    Account Number          Group or EBD
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
                                                                       Yes       No                                                                        Yes      No
I certify that I have the authority to request on behalf of the Customer, as lessee of the service numbers(s) listed on this form, or as the authorised agent for the
lessee, the porting of these service numbers to PowerTel Limited. I acknowledge that cancellation by the Customer of a local number porting request less than 3
hours before the scheduled cutover time may cause a Short Notice Return fee of up to $2,500 (plus GST) to be charged to the Customer.

Handover of Authorisation
I, on behalf of the Customer, authorise PowerTel to act on the Customer’s behalf and to sign and complete a PowerTel Porting Authorisation Form (“PAF”) and
associated paperwork for the purposes of porting the service numbers listed on this form to PowerTel at the service address listed below.
I, on behalf of the Customer, authorise PowerTel’s nominated representative to complete and sign on the Customer’s behalf and in the Customer’s name a new
PAF for the purposes of carrying out the port to PowerTel in circumstances where (untick if authorisation is not granted):
    This PAF expires                     Additional details are to be added                  Editing or deleting of details is required
This authority will remain in place for 12 months from the date of signature or until such time as PowerTel Limited is otherwise notified in writing by the Customer.
I certify that all the information contained in this application is both true and correct.
Name of Authorised Signatory:                                                                    Authorisation Signature/s:
Position / Title:                                                Business Name:                                                   ABN:
Service Address:                                                                                                                           Post Code:
Business Address:                                                                                                                          Post Code:
Business Contact Telephone No :                                                                                                            Date:


LNP PAFv2.9                                                                                                                                                       Page 1 of 1

				
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